Peter Odighizuwa shuffled into Buchanan County General District Court in leg chains, surrounded by police officers.
Hiding his face behind his green arrest warrant, Odighizuwa told Judge Patrick Johnson, "I was supposed to see my doctor. He was supposed to help me out. ... I don't have my medication."
Odighizuwa, a 43-year-old naturalized U.S. citizen from Nigeria, went to the Appalachian School of Law on Wednesday to talk to his dean, L. Anthony Sutin, about Odighizuwa's dismissal for failing grades, officials said. He shot Sutin and professor Thomas Blackwell, who taught Odighizuwa's contracts classes during the fall and winter, with a .380-caliber pistol, authorities and students said.
Also killed was student Angela Dales, 33, said State Police spokesman Mike Stater. Three other students were injured and were hospitalized in fair condition.
Prosecutors charged Odighizuwa with three counts of capital murder, three counts of attempted capital murder and six charges for use of a firearm in a felony.
A few minutes before his arraignment, Odighizuwa told reporters as he was led into the courtroom, "I was sick, I was sick. I need help."
When Johnson said he would appoint lawyer James C. Turk Jr. to represent him, Odighizuwa asked for another attorney who he named. But Johnson appointed Turk and said, "Once you've talked with him, I'm sure you'll see he can help you."
Odighizuwa will remain held without bond pending a preliminary hearing March 21.
Students ended the rampage by confronting and then tackling the gunman, officials said.
"He was angry. He thought he was being treated unfairly, and he wanted to see his transcript," said Chris Clifton, the school's financial aid officer.
"I don't think Peter knew at this time that it (dismissal) was going to be permanent and final," Clifton added.
The suspect, known around the rural campus as "Peter O," had been struggling with his grades for more than a year and had been dismissed once before. Clifton met with Odighizuwa a day earlier when the student learned he was to be kicked out of school.
Dr. Jack Briggs, who has a private practice a half-mile from the school, said Odighizuwa went downstairs from Sutin's and Blackwell's offices to a commons area and opened fire on students.
"When I got there, there were bodies laying everywhere," Briggs said.
Odighizuwa left the building and dropped his gun after being confronted. Students then tackled him and one who is a sheriff's deputy handcuffed him.
Odighizuwa kept saying, "I have nowhere to go. I have nowhere to go," said student Todd Ross, 30, of Johnson City, Tenn.
Justin Marlowe, a first-year law student from Richwood, W.Va., said the suspect had been in all of his classes.
"He was a real quiet guy who kept to himself," Marlowe said. "He didn't talk to anybod, but he gave no indication that he was capable of something like this."
Other classmates, however, described the suspect as an "abrasive" person who would regularly have outbursts in class when he was challenged by classmates or the professor.
"I knew he'd do something like this," said Zeke Jackson, 40, who tried to recruit him for the school's Black Law Students' Association.
The private law school has an enrollment of about 170 students. It opened five years ago in a renovated junior high school to help ease a shortage of lawyers in the region and foster renewal in Appalachia.
Sutin, a 1984 graduate of Harvard Law School, also was an associate professor at the school. He left the Justice Department to help found the school, and had worked for the Democratic National Committee and Bill Clinton's 1992 presidential campaign, according to the Web site of Jurist, the Legal Education Network.
Attorney General John Ashcroft issued a statement expressing his condolences to Sutin's wife and their two children.
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